The use of extracorporeal carbon dioxide removal to avoid intubation in patients failing non-invasive ventilation – a cost analysis

BMC Anesthesiology

Stephan Braune⁵  Hilmar Burchardi⁴  Markus Engel³  Axel Nierhaus⁵  Henning Ebelt¹  Maria Metschke⁵  Simone Rosseau²  Stefan Kluge⁵ 

[1] Department of Medicine III, University of Halle (Saale), Halle, Germany

[2] Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany

[3] Department of Cardiology and Intensive Care, Klinikum Bogenhausen, Munich, Germany

[4] Bovenden, Germany

[5] Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany

关键词: Treatment costs;    Cost analysis;    Mechanical ventilation;    Carbon dioxide removal;    Extracorporeal;   

Others  :  1230281
DOI  :  10.1186/s12871-015-0139-0

 received in 2015-07-05, accepted in 2015-10-22,  发布年份 2015

【 摘 要 】

Background

To evaluate the economic implications of the pre-emptive use of extracorporeal carbon dioxide removal (ECCO ₂ R) to avoid invasive mechanical ventilation (IMV) in patients with hypercapnic ventilatory insufficiency failing non-invasive ventilation (NIV).

Methods

Retrospective ancillary cost analysis of data extracted from a recently published multicentre case–control-study (n = 42) on the use of arterio-venous ECCO ₂ R to avoid IMV in patients with acute on chronic ventilatory failure. Cost calculations were based on average daily treatment costs for intensive care unit (ICU) and normal medical wards as well as on the specific costs of the ECCO ₂ R system.

Results

In the group treated with ECCO ₂ R IMV was avoided in 90 % of cases and mean hospital length of stay (LOS) was shorter than in the matched control group treated with IMV (23.0 vs. 42.0 days). The overall average hospital treatment costs did not differ between the two groups (41.134 vs. 39.366 €, p = 0.8). A subgroup analysis of patients with chronic obstructive pulmonary disease (COPD) revealed significantly lower median ICU length of stay (11.0 vs. 35.0 days), hospital length of stay (17.5 vs. 51.5 days) and treatment costs for the ECCO ₂ R group (19.610 vs. 46.552 €, p = 0.01).

Conclusions

Additional costs for the use of arterio-venous ECCO ₂ R to avoid IMV in patients with acute-on-chronic ventilatory insufficiency failing NIV may be offset by a cost reducing effect of a shorter length of ICU and hospital stay.

【 授权许可】

   
2015 Braune et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Kahn JM, Le T, Angus DC, Cox CE, Hough CL, White DB, Yende S, Carson SS. The epidemiology of chronic critical illness in the United States. Crit Care Med. 2015; 43:282-287.
• [2]Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2013; 369:2126-2136.
• [3]Jaber S, Jung B, Matecki S, Petrof BJ. Clinical review: ventilator-induced diaphragmatic dysfunction - human studies confirm animal model findings! Crit Care. 2011; 15:206. BioMed Central Full Text
• [4]Timsit JF, Zahar JR, Chevret S. Attributable mortality of ventilator-associated pneumonia. Curr Opin Crit Care. 2011; 17:464-471.
• [5]Agerstrand CL, Bacchetta MD, Brodie D. ECMO for adult respiratory failure: current use and evolving applications. ASAIO J. 2014; 60:255-262.
• [6]Terragni PP, Birocco A, Faggiano C, Ranieri VM. Extracorporeal CO2 removal. Contrib Nephrol. 2010; 165:185-196.
• [7]Kluge S, Braune SA, Engel M, Nierhaus A, Frings D, Ebelt H, Uhrig A, Metschke M, Wegscheider K, Suttorp N, Rousseau S. Avoiding invasive mechanical ventilation by extracorporeal carbon dioxide removal in patients failing noninvasive ventilation. Intensive Care Med. 2012; 38:1632-1639.
• [8]Burki NK, Mani RK, Herth FJ, Schmidt W, Teschler H, Bonin F, Becker H, Randerath WJ, Stieglitz S, Hagmeyer L, Priegnitz C, Pfeifer M, Blaas SH, Putensen C, Theuerkauf N, Quintel M, Moerer O. A novel extracorporeal CO(2) removal system: results of a pilot study of hypercapnic respiratory failure in patients with COPD. Chest. 2013; 143:678-686.
• [9]Crotti S, Lissoni A, Tubiolo D, Azzari S, Tarsia P, Caspani L, Gattinoni L. Artificial lung as an alternative to mechanical ventilation in COPD exacerbation. Eur Respir J. 2012; 39:212-215.
• [10]Del Sorbo SL, Pisani L, Filippini C, Fanelli V, Fasano L, Terragni P, Dell’Amore A, Urbino R, Mascia L, Evangelista A, Antro C, D’Amato R, Sucre MJ, Simonetti U, Persico P, Nava S, Ranieri VM. Extracorporeal Co2 removal in hypercapnic patients at risk of noninvasive ventilation failure: a matched cohort study with historical control. Crit Care Med. 2015; 43:120-127.
• [11]Perera PN, Armstrong EP, Sherrill DL, Skrepnek GH. Acute exacerbations of COPD in the United States: inpatient burden and predictors of costs and mortality. COPD. 2012; 9:131-141.
• [12]Nevins ML, Epstein SK. Predictors of outcome for patients with COPD requiring invasive mechanical ventilation. Chest. 2001; 119:1840-1849.
• [13]Esteban A, Anzueto A, Frutos F, Alia I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguia C, Nightingale P, Arroliga AC, Tobin MJ. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA. 2002; 287:345-355.
• [14]Ucgun I, Metintas M, Moral H, Alatas F, Yildirim H, Erginel S. Predictors of hospital outcome and intubation in COPD patients admitted to the respiratory ICU for acute hypercapnic respiratory failure. Respir Med. 2006; 100:66-74.
• [15]Texereau J, Jamal D, Choukroun G, Burgel PR, Diehl JL, Rabbat A, Loirat P, Parrot A, Duguet A, Coste J, Dusser D, Hubert D, Mira JP. Determinants of mortality for adults with cystic fibrosis admitted in Intensive Care Unit: a multicenter study. Respir Res. 2006; 7:14. BioMed Central Full Text
• [16]Menzies R, Gibbons W, Goldberg P. Determinants of weaning and survival among patients with COPD who require mechanical ventilation for acute respiratory failure. Chest. 1989; 95:398-405.
• [17]Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, Chastre J. Morbidity, mortality, and quality-of-life outcomes of patients requiring > or = 14 days of mechanical ventilation. Crit Care Med. 2003; 31:1373-1381.
• [18]Pfeifer M. Chronic critically ill patients from a pneumological perspective. Med Klin Intensivmed Notfmed. 2013; 108:279-284.
• [19]Bein T, Weber F, Philipp A, Prasser C, Pfeifer M, Schmid FX, Butz B, Birnbaum D, Taeger K, Schlitt HJ. A new pumpless extracorporeal interventional lung assist in critical hypoxemia/hypercapnia. Crit Care Med. 2006; 34:1372-1377.
• [20]Annual Business Report. 2014. http://www. novalung.com. Accessed 27 June 2015
• [21]Jegers M, Edbrooke DL, Hibbert CL, Chalfin DB, Burchardi H. Definitions and methods of cost assessment: an intensivist’s guide. ESICM section on health research and outcome working group on cost effectiveness. Intensive Care Med. 2002; 28:680-685.
• [22]Moerer O, Plock E, Mgbor U, Schmid A, Schneider H, Wischnewsky MB, Burchardi H. A German national prevalence study on the cost of intensive care: an evaluation from 51 intensive care units. Crit Care. 2007; 11:R69. BioMed Central Full Text
• [23]Consumer price index and inflation rates. German Federal Statistical Office. https://www.destatis.de/EN/Homepage.html. Accessed 27 June 2015
• [24]Rapoport J, Teres D, Zhao Y, Lemeshow S. Length of stay data as a guide to hospital economic performance for ICU patients. Med Care. 2003; 41:386-397.
• [25]Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007; 370:765-773.
• [26]Parviainen I, Herranen A, Holm A, Uusaro A, Ruokonen E. Results and costs of intensive care in a tertiary university hospital from 1996–2000. Acta Anaesthesiol Scand. 2004; 48:55-60.
• [27]Edbrooke DL, Minelli C, Mills GH, Iapichino G, Pezzi A, Corbella D, Jacobs P, Lippert A, Wiis J, Pesenti A, Patroniti N, Pirracchio R, Payen D, Gurman G, Bakker J, Kesecioglu J, Hargreaves C, Cohen SL, Baras M, Artigas A, Sprung CL. Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysis. Crit Care. 2011; 15:R56. BioMed Central Full Text
• [28]Edbrooke D, Hibbert C, Ridley S, Long T, Dickie H. The development of a method for comparative costing of individual intensive care units. The Intensive Care Working Group on Costing. Anaesthesia. 1999; 54:110-120.
• [29]Flaatten H, Kvale R. Cost of intensive care in a Norwegian University hospital 1997–1999. Crit Care. 2003; 7:72-78. BioMed Central Full Text
• [30]Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005; 33:1266-1271.
• [31]Heyland DK, Gafni A, Kernerman P, Keenan S, Chalfin D. How to use the results of an economic evaluation. Crit Care Med. 1999; 27:1195-1202.
• [32]Makris D, Desrousseaux B, Zakynthinos E, Durocher A, Nseir S. The impact of COPD on ICU mortality in patients with ventilator-associated pneumonia. Respir Med. 2011; 105:1022-1029.
• [33]Norris C, Jacobs P, Rapoport J, Hamilton S. ICU and non-ICU cost per day. Can J Anaesth. 1995; 42:192-196.
• [34]Gyldmark M. A review of cost studies of intensive care units: problems with the cost concept. Crit Care Med. 1995; 23:964-972.